Give Me Your Tired, Your Poor...Your Eyes, That Is
By Mark Mattison-Shupnick, ABOM
Release Date: July 2011
Expiration Date: August 30, 2012
Upon completion of this program, the participant
should be able to:
- Define accommodation and the ways
accommodation is overtaxed today.
- Understand the telltale signs of visual
- Learn how a small amount of plus
power (+0.65D), added to the lower
portion of a lens, can reduce visual
fatigue for patients ages 18 to 38.
- Understand how this new lens can
be described and recommended for any
single vision patient complaining of
Mark Mattison-Shupnick, ABOM, FNAO is currently director of education and training, program development for Jobson Information Services LLC, has more than 35 years of experience as an optician, was senior staff member of SOLA International and is a frequent lecturer and trainer.
This course is approved for
one (1) hour of CE credit by the
American Board of Opticianry (ABO).
Calling all Millennials and Generation
X-ers from 18 to 38 years old. Visit your
eyecare professional tomorrow and an
optician will help you with your tired eyes.
You know who you are: You just finished
an all-nighter studying for an exam; you
were in a texting duel while completing
27 successive tweets and simultaneously
watched three of the most popular YouTube
videos while playing “Toon Warz” and
“Speed Forge 3D” on your smartphone.
Your eyes must be very tired. Relax, we've
got a solution.
Every day, every hour, emmetropes and
single vision prescription wearers put a lot
of demand and natural stress on their
eyes. That's because we live in a “mediacentric” world, where the devices that
we spend so much time consulting and
socializing with, place a new and significant demand on accommodation. It's
often taxed to the max.
Sure there are lots of accommodative
solutions for presbyopes, but what about
single-vision (SV) wearers? Introducing
Relax, the new single-vision, free-form
design from Shamir, crafted specifically to
relieve visual fatigue.
WHAT'S THE PROBLEM?
In today's high-tech world the eyes are constantly focusing on PDAs, laptops, e-readers,
tablets and cell phone text messages. Focusing on close and mid-range objects, or small
letters and images on small screens is an
effort for the eyes. Especially when combined
with long work hours, this prolonged accommodative effort often leads to tiredness,
tearing, headache and blurry vision. Why?
Human eyes are at the peak of their accommodative capabilities around the age of 9,
after which there is a gradual decline with the
passing years. During ages 18 to 27, many
are spending countless hours reading,
researching and writing for college. By ages
28 to 38, accommodation can have a noticeable lag and can be difficult to sustain for
long hours of intermediate and close vision
tasks. Even if visual correction for close viewing is not required, the eyes need a solution
for the eyestrain created by tasks at this
everyday range of mid and near vision.
FOCUS ON THE RIGHT TARGET
Most people who are “connected” electronically spend 60 percent of their time in the
zone—intermediate and near. They suffer
visual fatigue and probably recognize its symptoms as eyestrain, but do little to make it better.
Part of the problem is that it's a changing
environment at near and mid-range. Today,
about 40 percent of all cell phones are smartphones, and more than 92 percent of the 18 to
38 age group owns a cell phone. Smartphone
penetration i.e., those with video, app and
gaming features is expected to overtake ordinary feature phones by the end of the third
quarter of 2011. In addition, about 27 percent
of the U.S. population or about 83 million
people are in this age group. Adding all this
up results in the following observations:
1. Visual demand at intermediate and near is
going to increase. 2. A significant part of the
population is in this problem age group, and
3. Accommodative fatigue affects both prescription and non-prescription wearers.
This means real opportunities if you have
the right solution.
In addition, the reliance on mobile devices
will continue to increase. For example, by 2020
most people will connect to remote server
networks like cloud computing rather than
personal computers. That means the screen
will often be handheld and vary in the distance
being viewed. Today, 500 million people use
Facebook; that's being social in the cloud.
Other examples are Hotmail and Yahoo mail,
Twitter and WordPress and video sharing sites
like YouTube. Want an opinion shared from
the cloud? Visit Yelp and TripAdvisor. Therefore, there's a significant opportunity for vision
problems for people, and an opportunity to
deliver solutions for the ECP.
ACCOMMODATION CAN BE TIRING
Reading, but more importantly the arm's
length world we live in online, taxes the
accommodative mechanism. Accommodation is the eye's ability to adjust lens shape
to produce a crisp, well-focused image on the
retina. As we said, the 28 to 38 age group,
depending on prescription and personal
vision traits begins to “see” the effects of
reduced accommodative ability.
As we age, we lose the art of
accommodation. But Relax lenses are aimed at more than the
pre-presbyope. In pre-presbyopia (38 to 42), focusing from
distance or near and back slows
down, making this age group
aware that something is happening. It's easier to recognize the
effect by the difficulty of focusing
on a menu in a dimly-lit restaurant. Focus and the loss of depth
of field from a larger pupil combine to make difficulty focusing
Of course, comfort and accuracy on any of
the gadgets described depends also on screen
size, font size and shape. The various software companies have spent considerable time
developing the right fonts to improve visibility.
But no matter what they do, watching a
movie on your iPhone and playing games on
that Droid for extended periods of time
strains the accommodative system. From
Pew Research, 18- to 38-year-olds have more
mobile devices and own three to four of the
variety of devices that are available. Why
does this size add to visual fatigue?
First, standard screens on mobile devices
and laptops create letters and graphic images
at what appears to be different depth relative
to the surface of the screen. That causes the
eye to shift focus back and forth between the
surface and the apparent position of the
image. The result is that the eye is always
shifting focus, and this accounts for the visual
fatigue that most computer users experience.
Next for some younger patients, they may
have a “lag of accommodation,” i.e., eyes that
fail to focus (accommodate) accurately for
the distance needed. The average lag,
described in optometric texts, is about
0.75D. It could be due to uncorrected hyperopia or may indicate accommodative insufficiency. Most young people with this situation
may go undetected without having a comprehensive eye exam but would benefit from a
small amount of plus to assist when needed.
Enter 3D—on cell phones, laptops, TVs
and in the movies. Again, the depth of perceived image changes from on screen to both
before and behind the screen creates an
effect called “vergence-accommodation
conflict.” This is an important effect and 3D
producers pay close attention to this for comfortable and restful viewing. Not everyone
will be using 3D all the time, but it will be a
part of the mix of gadgets and routines that
will continue to contribute to visual fatigue.
With displays of smartphones at about 3.5
inches (all four iPhone versions have a 3.5
inch screen measured diagonally), and the
shift to video availability, better image quality drove technological invention. Now that it is
possible, more people will be watching on
small screens but screen size hasn't increased
enough to reduce potential fatigue. It seems
that even though a larger screen would help,
purchasers buy smaller. The advantages of a
larger screen seem to give way to the software
and carrier's marketing.
It's clear that gadgets and small images can
stress accommodation. The result is “overwork” and strain to hold focus.
Simply stated, a lens that is designed to automatically relieve accommodative demand
would be an advantage. By adding a pinch of plus to the lower portion of the lens, reading and midrange demand is reduced. As a
result, closer tasks seem easier and
there is less effort to sustain clear
vision. That means one can work
at these distances visually stressfree for longer periods of time.
Consider the following analogy—myopes and new contact
lenses. When myopes go to contact lenses during that mid-life
crisis (early 40s), they uncover an
immediate need for reading glasses. That's because with contact
lenses they no longer get the benefit of the base in prism from their spectacle
lenses. Base in prism reduces convergence
and therefore the amount of accommodation
needed. The suggestion here is to add a small
amount of plus to the right place in a spectacle lens and make reading and mid-range
tasks easier. The result becomes an invisible
aid to everyday comfort regardless of how
much demand there is for sustained reading
and mid-range vision.
This small amount of plus can also correct
the lag that some patients experience. Having
extra plus available removes the awareness
of a lag.
INTRODUCING SHAMIR RELAX
Shamir Relax is a new lens designed to
replace single-vision lenses. The lens acts like
single-vision but the lower portion of the lens
incorporates a shift to a +0.65D plus power.
The design is a clever use of free-form technology. The prescription for the single-vision
design is combined with a +0.65D progression in the lower portion of the lens. This is
not the typical progressive as you know it.
Free-form cutting and techniques organize
this plus power with the Rx, frame dimensions, and patient PD and fitting height.
You may want to understand how long the
corridor is or if there is any blur or fitting
requirements. When this is free-form cut in
the lab, the design gains power quickly,
reaches 85 percent of the total power about
13 mm below the optical center (O.C.), and
full power in another 2 mm.
If this is a progressive power lens, is there
blur and where? We all have fitted low Add
(+1.00D, +1.25D) lenses to new presbyopes.
Rarely, if ever are there blur problems. The
most astigmatism created in a new Relax lens
is about 0.50D. That means the wearer will
probably not notice any blur at all. We know
from many companies' research that shows
most progressive wearers do not notice or are
not bothered by unwanted astigmatism until
it reaches about 1D. Therefore, there is no
need to worry.
The small Add helps with accommodation.
For this age range it can reduce accommodative demand up to 30 percent for mid-range
and near tasks. The design and small power
change also ensure effortless adaptation. As
a result, this can provide patients with
renewed energy at the end of the day.
PROGRESSIVE OR SINGLE-VISION?
This lens is classified as a single-vision lens. It is
used and recommended for patients that fit the
18 to 38 category, are heavy users of electronic
gadgets and agree that their eyes feel tired at the
end of the day. That of course suggests a comprehensive eye exam and a recommendation for
lenses that help relieve the visual
fatigue they feel daily.
Shamir Relax is available in a full
range of powers through the Shamir
network of Autograph partner laboratories. Choose from hard resin,
polycarbonate and 1.6 high-index,
clear and Transitions polarized and/or Drivewear to best meet patient
needs and budgets.
However, there is an argument for
thinner and lighter lenses. Since the
advantage of this design is to reduce
visual fatigue, it makes sense to also
reduce lens volume (thinness) and
lens weight to make that pair of
glasses as light as possible all the
time. Consult your lab for complete details.
THE RIGHT AUDIENCE
Let's review the right target audience. Consider the 18 to 38 group as an overall category.
Logically, pre-presbyopes are already seeing
the effects of reduced accommodative ability.
Some experience a lag of accommodation.
As we discussed, contact lens wearers are also
a logical target for Shamir Relax lenses. When 9 degrees tilt Fit to pupil center 16mm minimum wearing contact lenses, myopes especially, converge more and have more accommodative
demand so they would benefit from Relax.
Some practitioners may also consider these
lenses for lag of accommodation in teens. If
this occurs they may have difficulty reading
because they cannot sustain the same accommodative effort for long periods of time. A
small plus Add can relieve the problem.
ASK THE RIGHT QUESTIONS
“Do you have tired eyes, headaches, blurred
vision or neck and shoulder pain at the end of
the day?” Asking questions like this reaffirms
that the patient would like your help. When
the patient says, “Yes please,” tell them,
“Relax, I can help you with that, here's how.”
(This assumes that the prescription the patient
is wearing is correct.) When?
First, reception is the best time to
begin the assessment of why a
patient is visiting and an opportunity to define the benefits with
which they can leave. Next during
pre-testing, uncover comments
about visual fatigue. In the exam
room, a clear set of questions and
testing can confirm the need and
therefore the solution. Be sure to
describe these recommendations
during the hand-off to the optician.
This puts the optician in the know,
and continues the discussion for
fitting visual fatigue lenses.
If you think this makes sense for
you and your office, set goals, record
sales and measure your success.
AT THE DISPENSING TABLE
Before taking fitting measurements,
adjust the frame. Pantoscopic tilt should be
about 9 degrees with a small amount of face
Like other single-vision lenses, Relax lenses
are fitted using monocular PDs. Then measure fitting height at pupil center and
ensure that there is a minimum fitting
height of 16 mm. Of course, any digital camera measuring system and/or
a Shamir Panorameter will provide
When dispensing, demonstrate the
effect of the small plus power in the
lower portion of the lens.
CHANGING THE RX?
Are you changing the Rx by adding
an addition to a SV lens?
It's a good idea to discuss these
lenses with the
and have your
results added to
the patient's record.
Sending an e-mail
to the prescriber
listing the frame,
lens and fitting parameters would do the
trick. It also pre-empts the problem when a
patient returns to the prescriber to have the
lens verified, and the office doesn't understand the lens that was dispensed.
THERE ARE GOING
TO BE PRESBYOPES
Just a few words about those other folks.
They are candidates also. This lens can be
used for a mid-range and reading lens. Again,
Dr. Wan suggests that an SV intermediate
power lens with a +0.65D Add can make for
a useful lens at the computer.
Tell your patients, “Consult and socialize
online as much as you want. Relax, your
vision that is, with these new lenses.” Relax is
a new free-form lens design from Shamir
specially crafted to relieve visual fatigue in
the single-vision lens wearer. Add these lenses
to your toolbox and address an opportunity
that will make a difference in your practice
tomorrow. Get all the materials needed from
your lab and get started today.